Health strategies that help to manage weight regain after bariatric surgery
Bariatric surgery is presently the most effective method for sustained weight loss in the long term. However, many patients tend to regain some degree of weight after 2 to 3 years of having bariatric surgery. Here's how to maintain it
According to health experts, bariatric surgery is one of the best treatment options to “control” obesity as it helps patients to lose a large amount of weight and also to maintain it for a much longer period as compared to other weight loss methods like weight loss diets etc. However, obesity is a chronic medical condition just like type 2 diabetes or hypertension, which needs long-term management hence, regular follow-up is crucial for good long-term results.
Weight regain is one of the major concerns that patients have before undergoing bariatric surgery. Weight loss is associated with improvement in quality of life, associated co-morbidities and overall confidence but weight regain, on the other hand, can lead to a down-swing in all of the above.
In an interview with HT Lifestyle, Dr Aparna Govil Bhasker, Laparoscopic and bariatric surgeon at Saifee Hospital, Apollo Spectra, Namaha and Currae Hospitals in Mumbai, shared, “Bariatric surgery is presently the most effective method for sustained weight loss in the long term. However, many patients tend to regain some degree of weight after 2 to 3 years of having bariatric surgery. The quantum of weight gain is variable and depends on many factors.”
She listed some of these factors as:
1. Hormonal and metabolic factors - Bariatric surgery procedures lead to an increase in certain gastro-intestinal hormones like GLP-1, PYY, GIP etc. which increase satiety and reduce hunger. The appetite hormone called Ghrelin also decreases leading to decreased food intake. However, with passage of time, the effects of these alterations diminish resulting in some degree of weight regain.
2. Non-adherence to dietary guidelines - People with obesity are more prone to gain weight as compared to normal weight people. Hence, the quality of diet post bariatric surgery is very important. It is essential to have a moderately healthy diet and avoid high calorie food, snacks, junk food, sugary sweets and beverages, alcohol etc. Nutritional counselling and regular follow up help in guiding patients into a healthier lifestyle.
3. Physical inactivity - Patients who are physically active tend to maintain the weight loss for a much longer period of time. Inadequate activity and a sedentary lifestyle after bariatric surgery can contribute to weight regain. In some cases, there may be joint related issues or other mobility issues that may lead to insufficient activity levels. Such patients are also more prone to weight regain.
4. Mental health conditions - Patients with mental health issues can have psychological issues that can slow down weight loss. Lack of motivation, depression and some anti-depressant medications may also contribute to inadequate weight loss and weight regain. Eating disorders like binge eating can persist or re-emerge after surgery and can be a contributing factor for weight regain.
5. Surgery related factors - The tissues in the body are elastic in nature and can enlarge over a period of time. This varies from patient to patient. It also depends on the initial size of the stomach pouch, degree of mal-absorption and the size of the anastomosis in bypass surgeries. Rarely, there could be a gastro-gastric fistula that may be the causative factor for weight regain.
6. Medications - Certain medications like anti-depressants, oral contraceptives, immune-suppressants, steroids etc. may need to be taken in some patients and can contribute to weight regain.
Can we manage weight regain after bariatric surgery?
Dr Aparna Govil Bhasker revealed a few strategies that help to manage weight regain after bariatric surgery. These include:
1. Regular follow up - A bi-annual or annual follow up is a must after bariatric surgery. It helps to keep the nutritional deficiencies under check and also helps to maintain the lost weight. Frequent contact with the bariatric team also helps to motivate patients to keep up with a healthy diet and lifestyle.
2. Attending support group meetings - Most bariatric teams organize regular support group meetings for post bariatric surgery patients. In these meetings, patients get to interact with each other which in turn leads to motivation, inspiration and increased enthusiasm to start or maintain healthy habits.
3. Self-weight monitoring - Patients must be encouraged to monitor their weight at home once in every 15 days. They must be sensitized about weight regain and if the weight shows an upward trend from the baseline weight achieved, they must immediately get in touch with the bariatric team.
4. Diet and physical activity - For small degree of weight regain, dietary modification and an increased emphasis on physical activity may help to get back to the lowest weight achieved. This must be done under supervision and with help from a qualified dietician and exercise specialist.
5. Weight loss medications - If diet and lifestyle modification alone are not working effectively, certain medications can be added to help to lose weight. Medications can be advised by the bariatric team and can help to lose upto 10 to 15 kgs of weight over a few months. Weight loss medications must always be accompanied with a healthy diet and lifestyle for optimum results.
6. Endoscopic measures - In case of anatomical issues related to surgery, endoscopic measures can be used to resize the stomach pouch or the anastomosis.
7. Revisional bariatric surgery - This may be considered for larger degree of weight regain and also if there is a re-emergence of co-morbidities such as type 2 diabetes. In revision surgeries the existing bariatric procedure is usually converted to another more potent operation.
Dr Aparna Govil Bhasker highlighted, “Obesity can be controlled effectively but the key thing is to understand that people with obesity need life-long support. Bariatric surgery is just one cog in the wheel of weight loss. Weight regain is a reality but can be managed by the above mentioned methods which are usually used in combination with each other. Regular follow up and good compliance is the key to long term success after bariatric surgery.”